Watanabe Shinichi, Liu Keibun, Kozu Ryo, Yasumura Daisetsu, Yamauchi Kota, Katsukawa Hajime, Suzuki Keisuke, Koike Takayasu, Morita Yasunari
Department of Rehabilitation, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan.
Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, Gifu, Japan.
Ann Rehabil Med. 2023 Dec;47(6):519-527. doi: 10.5535/arm.23056. Epub 2023 Nov 22.
To examine the association between the mobilization level during intensive care unit (ICU) admission and independence in activity of daily living (ADL), defined as Barthel Index (BI)≥70.
This was a post-hoc analysis of the EMPICS study involving nine hospitals. Consecutive patients who spend >48 hours in the ICU were eligible for inclusion. Mobilization was performed at each hospital according to the shared protocol and the highest ICU mobility score (IMS) during the ICU stay, baseline characteristics, and BI at hospital discharge. Multiple logistic regression analysis, adjusted for baseline characteristics, was used to deter-mine the association between the highest IMS (using the receiver operating characteristic [ROC]) and ADL.
Of the 203 patients, 143 were assigned to the ADL independence group and 60 to the ADL dependence group. The highest IMS score was significantly higher in the ADL independence group than in the dependence group and was a predictor of ADL independence at hospital discharge (odds ratio, 1.22; 95% confidence interval, 1.07-1.38; adjusted p=0.002). The ROC cutoff value for the highest IMS was 6 (specificity, 0.67; sensitivity, 0.70; area under the curve, 0.69).
These results indicate that, in patients who were in the ICU for more than 48 hours, that patients with good function in the ICU also exhibit good function upon discharge. However, prospective, multicenter trials are needed to confirm this conclusion.
探讨重症监护病房（ICU）住院期间的活动水平与日常生活活动能力（ADL）独立性之间的关联，ADL独立性定义为Barthel指数（BI）≥70。
这是一项对涉及9家医院的EMPICS研究的事后分析。在ICU住院时间超过48小时的连续患者符合纳入条件。每家医院均根据共享方案进行活动评估，并记录ICU住院期间的最高ICU活动评分（IMS）、基线特征以及出院时的BI。采用经基线特征调整的多元逻辑回归分析来确定最高IMS（使用受试者工作特征曲线[ROC]）与ADL之间的关联。
203例患者中，143例被分配至ADL独立组，60例被分配至ADL依赖组。ADL独立组的最高IMS评分显著高于依赖组，且是出院时ADL独立性的预测指标（比值比，1.22；95%置信区间，1.07 - 1.38；校正p = 0.002）。最高IMS的ROC临界值为6（特异性，0.67；敏感性，0.70；曲线下面积，0.69）。
这些结果表明，在ICU住院超过48小时的患者中，ICU功能良好的患者出院时功能也良好。然而，需要进行前瞻性多中心试验来证实这一结论。
